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CG is more prolonged and severe than expected Keijser. Knaevelsrud. Hansson. De Jaegere. many researchers believe that CG Willcock. (2011) reported that in a sam. Spousal bereavement is the MDD and/or PTSD. despite this.
tive way. Lobb. 2007). outpatients have both CG and MDD. We discuss healthy grief or uncompli. jose. 2007. As a result. Portugal
(Received 7 April 2013. 4. 2007. Nikoletti. Zuckoff et al. & Schut. Newson et al. Castro & Rocha. Taking
(Golden & Dalgleish. 2006). 2001). Folkman. Schut. 3. BDI and IES-R reflect the effectiveness of the intervention
along the longitudinal profile. complicated grief
Grief is a well-marked event with powerful meaning in indi.. 1998.cespu. intrusive thoughts. Email: monica. Wittouck. Loh.
Conclusions: These results reinforce the importance of brief interventions that combine a reduced number of sessions with
lower costs. de Keijser. However. 2006).pt
Ó 2013 Taylor & Francis
. Kato & Mann. 2000.6% have both CG
Portzky. Hosman. Newson. Jenkins.. depressive and traumatic symptoms
compared to the controls. 2001. 2010.UnIPSa. and its effectiveness has been contro-
versial. 2011. & van den approximately 40% of the general population meet the crite-
Bout. & van Heeringen. therefore. Gandra. &
et al. they display symptoms that meet
However. Stroebe et al. during a mourning process. that in addition to CG.
to the level of functioning prior to the loss (Newson et al.. &
ability to function in everyday life is regained (Boelen & Monterosso. cognitive narrative intervention. Stroebe. Simon et al. affects the individual’s functional capacity (Tomita PTSD. & Prigerson. No. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief
(CG) for controlling post-traumatic and depressive issues. CESPU. 2007. Prigerson et al. Wittouck et al. Bonanno. 2003.2013. loss of interest. sented with MDD symptoms. such as MDD (Zisook.alison. 2002.rocha@iscsn. and Prigerson (2004) reported that
vidual lives (Boelen. and 69% show triple co-morbidity. the criteria of other disorders as well.
Method: The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ). widowhood. Kristjanson.com. 1995b).sa@gmail. Silva (2010) concluded that 70.38 to 4. (2007) found
(Bonanno et al. Hek. emotional and cognitive subjectivation. such as sadness. intervention in this area is
type of loss that most often results in psychological and psy. Wagner.
ple of elderly patients.
et al. & Judd. clinically relevant and should at a minimum address this tri-
chiatric referral and leadings to severe and prolonged feel. 1994) or PTSD (Schut.. the process is referred to as complicated grief Shuchter. 354–362. & ria for CG and not for MDD or PTSD. Monica Sa* and Jose Carlos Rocha*
ISCS-N. when this process is not experienced in a norma.8% had CG.833164
RESEARCH ARTICLE
Randomised controlled trial of a cognitive narrative intervention for complicated
grief in widowhood
Virginia Barbosa. 1999) that are validated
presents a 2. bereaved elders with CG are likely to meet the criteria for
2011. & Tiemeier. Jane-Llopis.9% of psychiatric
& Kitamura. the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). Van Autreve. Prigerson developed yet (O’Connor. Hofman.org/10. 1995b). Cruess. Mazure. van den Hout. many people
cated grief when the loss turns out to be accepted and the experience various symptoms (Kristjanson. 1991). It has been
(95% CI 1. the use of narratives has demonstrated
*Corresponding authors.. The loss of a spouse Kang & Yoo.. this into account. & Stroebe. Sledge. accepted 5 August 2013)
Objective: The implementation of bereavement interventions is frequently requested. 2006.42-fold increased risk of experiencing CG and acceptable for patients (Mu~noz.1080/13607863.
metaphorisation and projecting. Aoun. There
were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n ¼ 82). Prigerson fit from short-term interventions (Jane-Llopis & Barry. http://dx. CICS . the Inventory of
Complicated Grief (ICG). 2005. On the other hand. & Anderson. The bereaved
elders with the 40 highest ICG values (25) were randomly allocated into two groups: the intervention group (n ¼ 20) and
Downloaded by [University of Liverpool] at 17:16 07 October 2014
control group (n ¼ 20). 73.. 2012. 2014
Vol. BDI and IES-R assessments were repeated. (3) Two months later. and prevents their return and PTSD. CG is not yet included in stated that the best treatment for CG may have not been
the DSM-4 (Jacobs.21).
Results: Outcome measures showed a statistically significant reduction of CG. 18. and 49% met the criteria for
2007). Very high effect sizes for the ICG. in addition to CG. 2011) and that there is no
is a diagnostic entity that is distinct from major depressive well-defined protocol for psychological interventions in this
disorder (MDD) and posttraumatic stress disorder (PTSD) area (Stroebe.doi. 2006). Paulus.
Maercker. Aging & Mental Health. the ICG. (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to
participate in an intervention with four weekly 60-min sessions addressing recall. de
(CG). 2003. thus. Bout. Lichtenthal. Clisnicians would bene-
ings of grief and loneliness (Parkes. which is reflected in an increased adherence to the programme along with high effectiveness.
Keywords: randomised trial. and
van den Bout. 2011). 55% of complicated grievers pre-
Boelen. ple group of co-morbid symptoms. 1999). & Dijkhuis. 2008.. 2006).

ous session. Parkes. presence of
Glaser. 2013). The
The current study. silence and reflection of meaning. Interventions for CG informed consent was requested from eligible
using narrative procedures of meaning-making. ual (Jane-Llopis & Barry. sharing memories. Forty of these. Repeated from a specific episode related to the loss. There are three sequential phases: ond step was the exploration of the cognitive components. Sousa. (Neimeyer. metaphorisation.
has therapeutic effects (Pennebaker. 2006). & Berman. Nezu & Nezu. This can be discussed as follows ‘Does this narrative
criteria were eligible.
cognitive narrative therapy (CNT). 2002a). were used. what would
the intervention group began a programme based on you think he would say?’ Finally. 2004) would enable the construction of robustness of the treatment based on an intervention man-
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a better-adapted bereavement narrative. performed in Portugal. such as para-
into either the intervention group (n ¼ 20) or the waiting phrasing. (2) Participants (N ¼ 40) were then niques eliciting metaphors from the perspective of another. aimed to manual should be descriptive and allow the investigator to
evaluate the effectiveness of cognitive narrative interven.
Intervention
Frank. choose a metaphor/title unifier. projecting
new goals and writing. A therapy or psychotropic medication use were excluded. 2008). consistent with the methodology of CNT. make adjustments.
narrative can also be seen as an adapted instrument for the Forty eligible participants were selected for this study. Our attention focuses on the Manual of
tion in reducing the total values of complicated grief. complicated grief in widowhood
Careful use of sensorial memories with patients at risk To achieve our objective. ‘If it was a
Sousa. & Rocha. 2005) and thoughts substance abuse or dependence. the objective of this session was to
Method evoke the most significant episode of loss and to make
Trial design clear the meaning of the deceased.34). It was necessary to shorten the number
pants by examining differences between two groups: the of sessions due to time constraints. including robustness tests of intervention and sion addressed emotional and cognitive subjectivation. two months projecting took place. the expression with apparent or previously reported problems related to
of emotions (Stroebe.
also to explore and evaluate their meaning. 2005. to explore different meanings for the chosen episode and to
considering the cut-off value for this instrument (Frade. (3) Finally. Pacheco. meaningful future projecting narratives. Initially. BDI and IES-R on members of both groups. just as participants.
bias control (Nezu & Nezu. have shown to be effective and of
therapeutic value (Lichtenthal & Cruess. providing an alternative to the root meta-
in northern Portugal. and those participants in For example. while still remaining
IG (intervention group) and controls (control group. Aging & Mental Health 355
positive results in interventions with the bereaved (Currier. it is important to consider the
for PTSD (Rocha. Kiecolt-Glaser. Prigerson et al. with. The programme
out intervention. and they were then asked to evoke memories
longitudinal randomised controlled clinical trial. is a life together. & Rocha. emotions were activated. in which the objective was for the patient
with the highest ICG levels (equal to or greater than 25. 1994.
assessed with the BDI and IES-R.10. Schut. Those who fulfilled the inclusion phor. The metaphors created in the projecting phase had
Participants the purpose to generate a more positive envisioning of the
Bereaved elders were recruited from three nursing homes circumstances. & severe depression with a risk of suicide. severe hearing difficulties. The study was disclosed in detail and
2001. & Reynolds. used not only to refer to events. 2010. and (b) cognitive narrative intervention (inde. ‘If your husband/wife was here. Individuals
Neimeyer. in contrast with the previ-
variables). For example. 2008. 1995a). Houck. as well as tech-
list group (n ¼ 20). The third session involved
for the sociodemographic questionnaire.
task of making sense. 2010). but with age varying between 65 and 92 years (M ¼ 80. The Patients described the episode and structured their experi-
variables considered are the following: (a) complicated ence with sense of authorship. or current psycho-
meaning reconstruction (Gonçalves. 2002b). what title would you give?’ Frequent use
consented to participate and have been randomly allocated of specific interview skills was suggested. Sa. 1988). 2008).. The therapist
invited the patients to build up and reconstruct several nar-
ratives. the patients built and experimented
after the intervention.
retelling the story of the death. Patients described the
importance of the deceased and their journey through
This study. These findings also sug-
gest that complicated grief is a specific condition in need of Manualised cognitive narrative programme for
a specific treatment (Lichtenthal & Cruess. spousal loss over six months ago represent a more adaptive functioning?’
. waiting list). 2005). during the fourth session. we repeated the evaluation with the with other possible organisations of the episode. 2010. approved by an institutional review board. and the creative use of metaphors promotes dementia. and the sec-
pendent variable).
(1) assessment of the total value of the Inventory of followed by the realisation of associations between
Complicated Grief of bereaved elders and data collection thoughts and emotions. was reduced to four individual weekly sessions lasting
approximately 60 min each. The first session involved
recalling narratives. generating
ICG. (Gonçalves. psychotic symptoms. SD ¼ 7. and age over 60 years were the criteria. The second ses-
measures. & Stroebe. movie or a book. cognitive narrative psychotherapy: manual of brief therapy
depressive and traumatic symptoms in bereaved partici. coherence and diversity of
grief. Shear. depressive and traumatic symptoms (dependent cognitive and emotional content.

a 19-item measure Statistical methods
of CG (Frade et al. (2) After evaluating the instruments’ cut-off values and
ity of the intervention by the IG. . Thirteen of the 53 cases displayed border. The ICG. Table 1 describes participant characteristics for
resulting from activation of sensory experiences with each group. as well as for each patient. Afonso. We used the IBM SPSS Statistics soft-
IES-R. a non-parametric
chi-square test was used to compare frequencies and prev-
alence between groups. variable was analysed and compared between groups at
ties in terms of reliability (Cronbach’s Alpha: ICG. attrition of one participant in the IG due to his own death. . (c)
end of each session.
the IG and control group and (in the case of the IG) to
contextualize the loss. These data were utilised to and there is no bias related to missing cases in either
screen eligibility criteria.91. we also applied a multivariate general lin-
administered the Inventory of Complicated Grief. issues with session scheduling did not arise. patient’s acceptability with the intervention programme. Cases ear model (GLM) of repeated measures for CG. and (d) number of participants who completed
were monitored by supervisors to ensure that the therapist the last evaluation (n ¼ 19) (see Figure 1). Barbosa et al. and the and confidentiality. institutions. There were no signifi-
cant differences between groups in all characteristics.
At the beginning of each session. Therapy sessions were monitored. none of
A brief SDQ was delivered to collect data from the the cases had been lost at the final evaluation (see
bereaved elders. 2010). 1973).94).
completion of the selection process. control homogeneity between group.
session. names were replaced with numbers to protect anonymity
sive symptoms (Vaz Serra & Pio Abreu. Regarding the
Outcome measures
controls. sociodemographic characteristics. & Rocha. 2004).
tionship and contextualisation of the loss from the however. order to undertake an analysis of evolution over the longi-
pants had CG. 356 V.
bereaved’s perspective. Analysis of attrition rates in the sample
sion in CNT. a summary of the Randomisation
previous meeting was presented. The dependent variables were
operationalised with three measurement instruments in
their Portuguese versions: the ICG. who had undergone training and continued supervi. lated the effect sizes of the intervention. Both groups’ partici-
phase described in CNT manuals was not performed due pants underwent the same sampling and assessment proce-
to increased risk of traumatic recall (Rocha. we calcu-
were administered at pre-treatment and again at a two. calculator. each
It is important to note that the sensorial objectivation with 20 participants (see Figure 1). Twenty-nine did not sive and traumatic symptoms. tudinal profile (the influence of time factors and the inter-
line symptoms of CG. 2002a. Gl oria. . The treatment was manualised and described The values of attrition rates for IG considered were the
in a detailed session-by-session protocol to increase treat. the psy-
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number of participants who completed the intervention
chologist conducted a self-assessment. there is a clear indication of good acceptability. this included information regarding Figure 1). Given that all of the research was conducted in
personal identification. depres-
with higher scores were flagged.89. participants’
groups of statements reflecting the severity of depres. were homogenous in that they displayed similarities in
2002b). Vieira. flagging those cases with a decrease in symptoms (better
evolution) on the longitudinal profile. (1) Each dependent
These instruments have adequate psychometric proper. a history of the couple’s rela. and they were excluded as a result. This was performed in
have CG. first assessment phase (T1) and at the second assessment
BDI. (3) With the consideration that the
Sample size previous effect–size analysis only includes between-
A total of 82 bereaved elderly were eligible and were groups effects. Four steps were followed. the BDI. which has 21 Before proceeding to the data analysis. 53 partici. at the number of participants in the intervention (n ¼ 20). dures. Some sessions (n ¼ 20). a conservative procedure adjusted to the number of cases. a 22-item measure of traumatic symptomatology ware (version 19) for statistical analysis and effect size
(Castanheira. using the Hedges
month follow-up. groups: an intervention group and a control group. the BDI and the IES-R phase (T2) using t test analysis. IES-R.
brief questionnaire was used to evaluate the acceptabil.
Thus. 2006). following: (a) number of initial participants (n ¼ 20). 1994. of the 20 participants initially contacted.. Subsequently. and they were also excluded.
Therapists and treatment reliability
Treatments were conducted by the first author of this
work. there was no abandonment during the four sessions
of the intervention programme or the subsequent evalua-
tion (adhesion ¼ 95%.
. there was an exploration and summarisation of These participants were randomly allocated into two
the patients’ reactions. (b)
ment reliability. In addition to these instruments. There was
adhered to the protocol. sug-
gesting that randomisation was successful. we presented the descriptive values of the
chosen (see Figure 1). Upon actions (time groups) in the intervention programme. and at the end of each The selected sample contained 40 participants (N ¼ 40). attrition rate ¼ 5%). 40 participants were (4) Finally. The participants in the IG and control group
intense traumatic emotions (Gonçalves.

At T1 for the IES-R. at T2. SD ¼ 7. As seen in Table 2. using a repeated meas-
for independent groups. there is a significant difference
between groups for complicated grief (p < . there should
(M ¼ 42. at T1. tive programme’s second evaluation control intervention
significant differences between groups.45) compared to the controls
cant differences between groups. in T2.
can be compared when addressing the effectiveness of an
with a significance level of p < . SD ¼ 7. The IG
had a lower mean (M ¼ 25.
line assessment.31). Among Regarding the effect size analysis of the cognitive narra-
the baseline BDI scores (see Table 2). how-
Comparison between IG and controls outcomes in the ever. Flow of participants through each stage of experiment. at the base-
ures analysis. The IG had a lower
intervention. SD ¼ 5. this statistical procedure did not suffi-
We calculated the mean of the ICG. we can say that the value of the ICG.80. which is expected.32. there is no significant difference between groups on
the ICG.80. nevertheless. we observed
There are two essential conditions with which outcomes
a very positive difference in traumatic stress outcome. we noted non.
line.73). the
. SD ¼ 6.01). 2002). there are very significant differences between the
first and second phases groups. at T2. However. there should not be statistically signifi-
mean (M ¼ 15. BDI and IES-R scores
ciently clarify the intervention effects on traumatic stress. Aging & Mental Health 357
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Figure 1. while at T2. (see Table 2).01.
Results considering the randomisation procedures.
at T1 and T2 and compared the differences using the t test
this issue will be addressed later. we found a significant differ-
ence between the groups. Due to problems with the base-
be significant differences between groups (APA.46) when Effect sizes
compared to the controls (M ¼ 39.

with the IG displaying
calculating the value of the Pearson chi square. 2000. the IG showed a positive evolution for 16 cases Discussion
(84. At T2. The response options ranged from 0 to 10.
had CG. Wittouck et al. indi. the IG contained 8 participants with
reducing complicated grief. Therefore. leading to a better and more adaptive life. using the IES-R.79 1. 2003). the controls showed a
T2.037
Time IES R Before and after intervention 1 31.69 . 2002a. Neimeyer. depressive and traumatic symp-
PTSD. Importance of intervention 19 9..05. Despite these disparate differences
along the longitudinal profile. n M SD
Table 5 shows that we obtained very satisfactory answers.. 2007. in this case. 2011). Examining Table 4. 2007. Thus. although complicated grief was the main
between the two groups. In the first evalua-
ness of a four-session cognitive narrative intervention
tion. thus.89 .
prevalence of CG of (80%) that corresponds to the posi. this randomised controlled trial evaluated the effective-
MDD cases in the IG (n ¼ 8. As shown in Table 3. 2002b).
Cramer.56
cating that the programme was important for the partici. Help me decide better 19 8. Programme acceptability as judged by the participants.01) for the ICG. there was an
between the IG and controls at T1. to deconstruct the metaphors carrying
effect (p < . In turn.
Neimeyer. We emphasise that the participants see this Additional support 19 9. 1999. 95% of participants still problems..00
Time groups IES R Before and after intervention 1 44. By
the outcome variables (p < . p < . we see that at T2. The results of these sessions are encouraging.1%). The effective-
tion for the ICG and IES-R (p < .71 . at T1. afterwards.
narrative programme
Intervention group participants responded to questions Table 5. but we
idea that most people can improve if they discuss their life
found significant differences between the groups at T2.67 .
Time df F p
Time ICG Before and after intervention 1 35.47
Importance of seeking help 19 9. and that it is important to receive such help when solving
tive evolution of 16 participants. 2008.001
Time BDI Before and after intervention 1 17. we obtained a value less ment of complicated grief (Boelen et al.00
Time groups ICG Before and after intervention 1 14.50
with an average variation (approximated) of 8 to 10.01.
Multivariate repeated measures (time effect and encouraging patients to face their personal stories and to
interception effect) work creatively through their loss is important for the treat-
Using Mauchly’s test of sphericity. the BDI and the IES-R com-
did not find significant differences between groups in
pared to the controls.2%).. Aging & Mental Health 359
Table 4. The IG felt that they received more support
. the BDI and the IES-R. narrating the episodes and constructing meaning for
their emotions and thoughts (Gonçalves.05.00
p < .48 . To clarify thoughts and emotions 19 7. 1988). we concluded that the allows the patient to reflect on their situation and focus con-
intervention programme had a very positive time (T1–T2) cern and. At
participants with PTSD. 42.16 .11 1.
(p < .. 2000. we
lower mean values on the ICG.84 . Greenberg. There is a stay of 19 cases with MDD
results of other studies in the area of bereavement.56
pants.96
and emotions. The objective was achieved. In partic-
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(95%) in the controls.74 1. while the control group had 14 participants (see
toms in bereaved participants and examined differences
Table 3). MDD or PTSD. Currier et al.01). Pennebaker et al. while the controls had a positive evolution for
This study was part of a wider project that included the
15 cases (75%). we noted the presence of PTSD in
there was a large and consistent decrease of symptoms
some participants.05) for the BDI and a very positive effect on intercep.01).86 .
1999.82
intervention as an opportunity to clarify their thoughts To live a better life 19 7. 2002b. depression prevalence in
both intervention and control participants were similar at
T1.
regarding the acceptability of the intervention pro-
gramme.
than . There negative meaning and project alternative and additional
was also a positive effect on interception (time groups) adaptive metaphors onto the future (Gonçalves. and traumatic symptoms (IES R).
events. GLM repeated measures for complicated grief (ICG). there were significant differences between groups for
positive increase in the evolution of eight cases. The interception is. the
expected time effect and a significant interaction (time
IG had a positive development of 100%. rich in meaning for metaphorisation and projecting. CNT is innovative in the sense that the use of meta-
GLM do not meet the assumption of sphericity (Bryman & phors. we can be confident that the data from the 2002).00
Time groups BDI Before and after intervention 1 4. Boelen et al. as
clinical focus problem.32 . in contrast with the number of
ular. Kato &
Intervention group acceptability of the cognitive Mann. as it had no
groups). These results reinforce the general
frequency and prevalence of CG. additionally. the main effect. depressive symptoms (BDI). ness of this intervention is stronger than previously con-
ducted interventions in mourning (Allumbaugh & Hoyt.

157(1–3). Mancini. de Keijser. J.A.. Oeiras: Celta
Barlow. Azim. Psychia-
contaminated by social desirability. Barbosa et al. of measurement.A. Ehrenreich-May. Maccallum & Bryant. & van den
DSM (Gana & K’Delant. 2001). Moreover. 1052–1059. 134(5)... & ensure the well-being of the participants. (2007). V. 57(12). C. as there is growing evidence that the preferred Currier.
Castanheira. This study reinforces the We conclude that this investigation. J. Additional research is required to confirm the
tion that help is useful.
replicate the study in different contexts for generalisation of Bryman. 2007. needing specific intervention Bennett.S.T.. This intervention also had is advisable. June). Opatija. Journal of Abnormal Psychology...
increased adherence to intervention programmes (Kato &
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Mann. with a reduced
importance of promoting brief interventions. & Hoyt.A. complicated grief Cognitive and Behavioral Practice. paves the way
smaller number of sessions (Jane-Llopis & Barry. P. sociais: introduç a~o as t
ecnicas utilizando o SPSS para
Randomised controlled trials should be replicated using windows [Data analysis in the social sciences: introduction
larger samples (Bennett. Litz. it is necessary to mental validity.
therapist of the intervention programme (Jane-Llopis & 44(5). & Rocha.C. Litz. Wittouck et al. B. J. Second. In the controls. 2007). such as IG. van out intervention proved harmful. in the future. Neimeyer. 2010.
form randomisation of the participants in order to consider Frade. Stroebe. and. A. A.
is not currently recognised as a diagnostic entity in the Boelen.... an increase in the average total score on the IES-R in T2. Afonso. First. this would result in lowed. 2007). such as cognitive behavioural therapy (CBT) previous losses and emotional clarity on bereavement out-
come. This is important to
the most effective (Boelen et al. & Rocha. Portuguese validation. & Berman. Boisseau. & Stroebe. (1999). Vieira.A. Another inventario de luto complicado [Validation and adaptation to
indication for further research is that although the controls Portuguese inventory of complicated grief]... for instance. 2002. 311–314. J. Journal of Loss and Trauma.. J. Boelen. 1995b. D. D.. then. (2006. 2005. 46(3). C. 718–725. The & Insel. Third..
‘pathology’ that still is not officially recognised. 2005). depression and posttraumatic stress disorder? A test of incre-
tion of the results to men.. as well as to recog. 1999. as well as long-term Editora. Coifman. J. we can due to the risk of activating traumatic symptoms (Rocha. B. K. it is important to
Allumbaugh. (2007). P. H. the bereaved felt supported throughout the mourn.
. Complicated grief and
the questionnaire responses regarding satisfaction may be uncomplicated grief are distinguishable constructs. & Cramer. 116(2). 2007. 18(3). van der Houwen et al. Piper. BDI and IES-R. symptoms. women usually share the percep.. Criteria for evaluating treatment guidelines. tion of a cognitive-behavioral intervention for prenatal grief.
ence (Stroebe et al. A. (2012). Paper presented at the European
For future direction of research in this area... 360 V. G. S. A.. 277–284. Boisseau. to be cautious with the sensory memories
high acceptability of among participants.
2011).. ures be supplemented by a more detailed clinical assessment
ing process. Croatia..M. Introduction: New directions in bereave-
ment research and theory.I. for future investigations.. Schut. 2010). (2003). Bout. S.L. Paredes:
did not participate in the intervention. D. In this inter. Kruse.
orally and were noted by the investigator.. 2012. the benefits of seeking help. Boelen effectiveness of psychotherapeutic interventions for
et al. B. 248–259.
nise that mourning does not pass with the ‘cure of time’.
The characteristic symptoms of complicated grief do not American Psychologist. Jane-Llopis & Barry. Newson et al. so.H.. van den Hout. R.. 2007) with lower cost. Mu~ noz.. (2008).
This study has some limitations. it is bereaved persons: A comprehensive quantitative review. certain scales were used as instruments
related to lower perception of social support. B. 2011). This intensifies the assumption that an intervention. utility of this intervention. 161–173. Y. (2012).
Validaç a~o e adaptaç a~o para a lıngua portuguesa do
the possible effects of the therapist on the outcome. & Weideman. Neria. Journal of Consulting and Clinical Psychology. The
treatment for CG is CBT (Bennett et al. Litz. and therefore. (2010). Sousa. 2005).C. 2001. &
Barlow. Stroebe et al.C. 2012. which raises some reservations about treating a 75(2). In this study. 648–661. we suggest Congress of Traumatic Stress..
shown by the very high effect–size values obtained for the waiting list should ideally lead to the opportunity to receive
ICG. J. there was
der Houwen.. son between cognitive-behavioral therapy and supportive
counseling. 2005. in other areas of intervention. 2011. Gloria. Wittouck et al.. APA. 2011). American Behavioral Scientist.
population because the sample size is relatively small.. This may be related to gender. 2007.
342–351. Boelen et al.T. 2011). M. the importance of grief work. Treatment of complicated grief: A compari-
Ogrodniczuk. (2002).A.A. this study is not representative of the Bonanno. we suggest that these meas-
vention.. Journal of Counseling Psychol-
emotions. Pacheco. responses were given try Research. Psychological Bulletin.G. as evaluation with-
Hagl..
the comparison of the efficacy of different therapeutic Castro.L.. Ehrenreich-May.
monitoring of critical outcome measures (Kang & Yoo. J... Rosner. This also can educate the popu-
lation as well as the staff in nursing homes that the sample
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(Prigerson et al. as most of the in order to conduct a more rigorous identification of the
participants were women. 2011. Impact of event scale-revised (IES-R):
2007. & to techniques using SPSS for windows]. van den Bout..M. D. & van den Bout. & Rocha. the same protocol could be fol-
Kang & Yoo.
and CNT.
important to use more than one trained therapist and per.. which translates into greater adher. immediately after the last set of
interventions aimed at treatment (tertiary prevention) are answers to questionnaires (after T2). The moderating effects of
approaches. who was also the Bonanno.
resolve spontaneously.
suggest that high adherence to such programmes may be 2004).